Annals of emergency medicine
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The management of status epilepticus has improved over the past 20 years, resulting in a substantial decrease in the associated morbidity and mortality. Patients who have seizures that are refractory to initial pharmacologic interventions tend to have significant underlying toxic, metabolic, structural, or infectious disorders, and therefore management of refractory status epilepticus must focus on stabilization and on identification and correction of seizure etiology. Regardless of etiology, the faster the seizures are brought under control, the better the prognosis. ⋯ Benzodiazepines, phenytoin, and phenobarbital remain the most commonly used first- and second-line anticonvulsants, have proven effective in cases of status epilepticus, and should be administered within the first 45 minutes of management. For refractory status epilepticus, pentobarbital anesthesia is evolving as an effective and recommended treatment modality and should be instituted immediately after phenytoin and phenobarbital loading. The role of other anticonvulsants remains to be investigated in controlled clinical trials.
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To assess the quality of care delivered during first-responder defibrillation and to determine the potential efficacy of modifying existing automated external defibrillator designs to improve first-responder performance. ⋯ Current device algorithms result in effective delivery of the initial three shocks. However, firefighters often fail to interpose recommended intervals of CPR between further attempts at defibrillation. Modification of existing device algorithms to provide additional visual and auditory cues may be preferable to relying on the user to recall accurately all the steps in this infrequently performed procedure.
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Comparative Study
An introduction to the Bayesian analysis of clinical trials.
Although most clinical trials comparing therapies are analyzed using classical hypothesis testing and P values, such methods do not yield the information most useful to the clinician, that is, the probability that one treatment is more efficacious than another. Bayesian inference can yield this probability but only if we quantify our prior beliefs about the possible efficacies of the treatments studied. ⋯ Advantages of Bayesian analysis over classical analysis of clinical trials include the ability to incorporate prior information regarding treatment efficacies into the analysis; the ability to make multiple unscheduled inspections of accumulating data without increasing the error rate of the study; and the ability to calculate the probability that one treatment is more effective than another. Because it is likely that Bayesian methods will be used more often in the analysis of future clinical trials, investigators and readers should be aware of the two schools of statistical thought and the strengths and weaknesses of each.
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To delineate the topics discussed with families during the death notification process and to identify which of these topics are stressful to the physician. Also, the survey served as a needs assessment in designing an educational program for emergency medicine residents in death notification. ⋯ Factual information is discussed most often, and emotional issues are considered most stressful. Therefore, a program in death notification must address those issues that must be handled during a notification and provide mechanisms for residents to feel comfortable with emotional responses from the family.
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To determine if the deployment of a helicopter-borne nurse/paramedic team contributed to survival of victims of nontraumatic cardiac arrest in a rural setting. ⋯ Despite providing improved availability of advanced life support care in some cases, deployment of aeromedical teams had a negligible effect on patient survival from nontraumatic cardiac arrest in a rural setting.